Chapter IV: The Responsibility and the Morale of Physicians

Fenigsen, Richard, Fenigsen, Ryszard, Issues in Law & Medicine

Doing More Than Required. One of 20th century's most talented Polish poets was admitted to the Omega Clinic, Warsaw's fashionable medical center, with vague abdominal complaints. Nothing particular was found upon routine examination. Gastroscopy and X-rays were scheduled for the next two days. Meanwhile, the nurse observed the patient's condition at her rounds, that is, every hour.

However, my friend Dr. Jakub Winer somehow could not set his mind to rest. He wasn't even the patient's attending physician, just the director of the hospital; but he came to see the patient several times. He apparently sensed something unaccountable in the poet's condition. When he came again at 11:30 p.m., between the nurse's visits, he found the patient collapsing from a huge stomach bleed. The man could not even reach the bell. Surgery for the bleeding ulcer was immediately done and saved the patient's life.

One might observe that the doctor's alertness and diligence may have been heightened by his admiration for the patient's poetry and because the patient was a celebrity. That is probably true. But it is also true that Dr. Winer only did what good doctors in hundreds of hospitals are doing every day and every night for patients who are not celebrities.

They do it, not necessarily for lofty reasons. A doctor may do it out of a sense of duty, but he may also be moved by ambition, or he may be living up to his own obsessive personality. Most doctors who exert themselves without limits are simply compelled to do so by the logic of this work. In Den Bosch, after typical work hours the hospital doctors returned to their houses and were supposed to be on call. This was not good enough in some cases; in particular, to tend to patients whose condition might change within seconds, as with life-threatening disturbances in heart rhythm, or who may irreversibly deteriorate within minutes, as in cardiogenic shock, pulmonary edema, or large myocardial infarction in young men. Therefore, I put my hospital office in a room situated eight feet from the coronary care unit, and whenever such a "brittle" case was admitted I would spend a night or two on a couch in the office, getting up every half-hour to look at the patient, and darting off at every signal from the nurses. I was physically fit, able to take advantage of ten minutes of sleep, and to wake up in a second to full consciousness. Thus, these nights were not taking too heavy a toll on me. Neither was I much bothered by the displeasure of some other doctors who thought that I was setting unreasonable standards which they did not intend to adopt. Was it worth while? I happen to know the answer, and I owe it to the Central Bureau of Statistics from which every medical specialist in Holland received computerized statements showing the number of patients he treated, their diagnoses, as well as other data, including the mortality rate compared with the national average. As long as I alone was leading the department (1976-1981), the Central Bureau of Statistics statements showed, year in and year out, a thirteen percent mortality rate among my patients while the average national mortality rate of patients with the same diseases and in the same age groups held constant at seventeen percent.

Fighting Good Fights for the Patients' Sake. Doctor Ignaz Philip Semmelweis (18181865) has long been, and remains, our worthy example. He divined that puerperal fever (fever that follows childbirth), of which so many young mothers died, was an infection, and that at the University of Vienna department of obstetrics it was brought over from the dissecting-room on the unwashed hands and aprons of doctors and medical students. (36) Semmelweis was almost destroyed by the enmity of his incredulous and indignant colleagues, but he carried on through all difficulties his postulates of cleanness and antisepsis, and the epidemic was stopped.

Well, many of us have to fight battles on a larger or smaller scale. …

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